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Just some questions(:

have a few questions. I am not currenty TTC because I just had my
baby boy 4 months ago, but I was hoping someon would have the answers to
my questions here.

I am breastfeeding and have not yet
had a period since I have had my second son. It's actually been a whole
year since I have had one. Does anyone know if I am still ovulating
this soon? On Dr. Sears' website he says when your baby goes a
consistent 5 hours without nursing is when you eill start ovulationg,
but then again some girls get pregnant so quickly. Anybody know
anything about this?

Also what are the dangers of
getting pregnant so soon? My husband and I use natural family planning
as a form of birth control so in case we do get pregnant I want to be
aware of what could happen to me.

I am breastfeeding and have not yet
had a period since I have had my second son. It's actually been a whole
year since I have had one. Does anyone know if I am still ovulating
this soon?

Maybe maybe not.

On Dr. Sears' website he says when your baby goes a
consistent 5 hours without nursing is when you eill start ovulationg,
but then again some girls get pregnant so quickly. Anybody know
anything about this?

There's no hard and fast answer on this... your period will come when your body is ready to be pregnant again. We've known women to be period free for a decade with three babies in between.

Also what are the dangers of
getting pregnant so soon? My husband and I use natural family planning
as a form of birth control so in case we do get pregnant I want to be
aware of what could happen to me.

Pregnancy tends to murder milk supply. If you're OK with the idea of baby being on formula, stay as you are and take things as they come. If you are NOT, add condoms to your mix.

Pregnancies this close can also be a risk for the mom. Talk with your doctor about it.

And an infant and a toddler at once can be an extreme challenge to say the least.

Thanks! I hope this didn't sound too bad.

Normal. We get this question many times a week.

Tell you what... my doc said two years between delivery of the first and conception of the second to allow my stores to build up and be most beneficial to me and baby. As it happened, we never ended up having a second.

Many of our moms consider 2- 3 years spacing as ideal... the toddler becomes old enough to need mom less.

At the six-week postpartum checkup, the new mother is often told that she must begin contraceptive use immediately to avoid a pregnancy too soon. But what method should she choose? Research substantiates that women worldwide believe breastfeeding is associated with fertility reduction, but the question remains: How to use it effectively? The Lactational Amenorrhea Method (LAM) answers that question.

LAM is a newly developed interim family planning method that is based on utilization of lactational infertility for protection from pregnancy. LAM provides optimal infant nutrition, enhances immunity, prevents formula-related illness, and physiologically promotes mother-child interaction while simultaneously providing safe and effective temporary child spacing. It may be used for up to six months postpartum during full or nearly full breastfeeding and amenorrhea, and has been shown in clinical trial to be 99 percent effective.

The Lactational Amenorrhea Method was developed as a result of a meeting held at Georgetown University.1 It is designed to bring the health and fertility benefits of breastfeeding to the attention of family-planning providers and demographers. A mother is asked these three questions: Is your infant less than six months old? Are you amenorrheic? Are you fully or nearly fully breastfeeding? If she can answer yes to all three, she is counseled that her risk of pregnancy is less than two percent and she does not need a complementary family-planning method yet. She is also told that if any of these three parameters changes, she should introduce a complementary form of family planning to achieve this same low risk of pregnancy.

LAM is based primarily on a previously published approach2 and on the results of the Bellagio Consensus Meeting on Breastfeeding as a Family Planning Method held in l988.3 It serves as a guide from which individual programs can develop culturally appropriate presentations. Today, LAM or MELA (Spanish) or MAMA (French) is in use in at least ten countries and each program provides support for the mother's choice to breastfeed.

The available research has made it virtually impossible for scientific analysts to deny the impact of the LAM method. This method has undergone clinical trial in Santiago, Chile.4, 5, 6 A case-control intervention study was established whereby the control cohort was ascertained prior to the development of an organized breastfeeding support program at the Pontificia Universidad Católica de Chile. The intervention included prenatal education, immediate postpartum breastfeeding, rooming-in, decreased in-hospital use of formula, the establishment of a follow-up clinic, and the offer of LAM as an introductory family planning method.

LAM proved highly efficacious, with a pregnancy rate of less than 1/2 of 1 percent by six-month life table. The intervention more than doubled the percent of women who achieved six months of meeting LAM criteria. At six months postpartum, family planning coverage had increased from 78 percent to 91 percent with the inclusion of LAM in the "cafeteria" of methods available. Pregnancy rates remained lower for the intervention group for over a year, and the percent who were breastfeeding remained higher long after the intervention was over. The duration of amenorrhea was also extended. Where the control group performed similarly to other published studies on the duration of amenorrhea during full breastfeeding among similar women, 7 the intervention group had longer durations of amenorrhea, even when comparing the full breastfeeders in each group. Clearly, optimizing breastfeeding practices, even among full breastfeeders, extends the duration of amenorrhea and the impact of breastfeeding on fertility, even after LAM use has ceased.

Much work remains to fully educate providers of health care on the use of the method, especially those who doubt women's ability to monitor their own behavior. LAM may be offered to women who prefer to postpone introducing a complementary family planning method postpartum. In countries where family planning is not widely accepted, LAM is useful for populations who have no experience with family planning and may be hesitant to accept a so-called "modern" approach. LAM may also promote more effective use of other methods of family planning by breastfeeding women, since the method delays the use of a complementary method until the mother's fertility returns. LAM use results in improved breastfeeding support in the organizations that provide it and improved breastfeeding practices among the women who accept it. It also results in cost savings. When the costs of offering LAM, including retraining and reorganization, are accounted for, there remains a cost savings of 10 to 20 percent from the reduced need for personnel, drugs, formula, and bottles.

Research indicates that the LAM guidelines are very conservative and that each of the three parameters has considerable flexibility.8 Six months is an arbitrary time period; we know that continuing to breastfeed prior to each supplemental feed can extend amenorrhea and infertility. Full breastfeeding is not mandatory. Although a recently published manuscript seems to say that any breastfeeding will do during the first six months,9 it is clear from our work and that of many others7, 8, 9, 10 that more intensive breastfeeding is associated with longer durations of infertility. Even using menses as an indication of fertility return has some flexibility: the first ovulation is often associated with inadequacies in the luteal phase and other hormonal parameters. Based on worldwide experiences with relying on lactational amenorrhea beyond six months, we are now exploring what we call LAM II, a new more flexible method. Some centers have already begun independently to experiment with "LAM 9," a nine-month variant, and women who have self-selected to extend LAM are being studied in several settings.11, 12

The unique side effects of LAM, improved infant and maternal health and satisfied family planning workers, contribute in yet another way to the health of the community.

A mother's postpartum family planning choices now include a reliable interim method based on the behavior that is healthiest for her and her newborn.

ACKNOWLEDGEMENTS

Much of this paper is derived from the referenced articles and collaboration with Drs. Pérez and Valdés in Chile. Support for this publication was provided by the Institute for Reproductive Health, Georgetown University, under Cooperative Agreement with the Agency for International Development (A.I.D.) (DPE-3040-A-00-5064-01). The views expressed by the authors do not necessarily reflect the views or policies of A.I.D, or Georgetown University.

atural Child Spacing and Breastfeeding

A natural consequence of breastfeeding is the spacing of births. However, in some cultures, especially those that practice a variety of nursing styles, misconceptions about breastfeeding and fertility abound. A 1997 edition of Healthy Pregnancy magazine states, "Contrary to popular belief, breastfeeding does not halt ovulation, so it is not an effective birth control method."

As many fully breastfeeding mothers know, lactational amenorrhea (absence of menstrual periods as a result of breastfeeding) does affect their ability to get pregnant. Scientific data supporting this has been mounting for years. The Bellagio Consensus Conference on "Breastfeeding as a Family Planning Method" established that fully breastfeeding mothers who remain amenorrheic have less than a two percent chance of becoming pregnant in the first six months postpartum. "Fully breastfeeding" is defined as supplementing no more than one or two mouthfuls a day and waiting no more than four to six hours between nursings. A woman who is practicing the Lactation Amenorrhea Method (LAM) relies on exclusive or nearly exclusive breastfeeding for postponing or avoiding pregnancy during the first six months after childbirth or until her periods return, whichever occurs first.

Many breastfeeding mothers find they remain amenorrheic longer than six months, especially mothers who practice a style of nursing that Sheila Kippley calls "ecological breastfeeding." In Breastfeeding and Natural Child Spacing, Kippley describes ecological breastfeeding as the kind of nursing that most effectively spaces babies: nursing on cue, keeping baby close, providing all nourishment and liquids at the breast for the first five to eight months, and nursing to comfort the baby. It does not include the use of bottles or pacifiers, mother-baby separation, parent-imposed feeding schedules or restriction of night nursings. All of these practices limit the nipple stimulation that suppresses ovulation.

The chance of pregnancy occurring during the first three months of ecological breastfeeding are practically nil. During the second three months, there is a less than 2 percent chance of becoming pregnant before the first menstrual period. After six months postpartum there is a six percent chance of becoming pregnant before the first period. That means that an amenorrheic woman who is relying on ecological breastfeeding alone has a 94 percent chance of not becoming pregnant during the second six months postpartum.

Women who practice ecological breastfeeding average 14.6 months of amenorrhea. Seven percent experience a return of their menses in the first six months following childbirth. Thirty-seven percent get their periods back during months seven to twelve. Forty-eight percent get their periods back sometime during the second year after childbirth. Eight percent go longer than two years without periods.

Despite the variability in the return of menses, there is not as much variation in the return of fertility as might appear. Women who experience a return of their periods in the first six months tend to be infertile for a few cycles, while the early cycles of women experiencing a longer period of amenorrhea are often fertile.

A Leader may be one of the few people a nursing mother knows who is willing to help her find information about breastfeeding's effects on contraception and other natural methods of child spacing. Women differ in their reasons for using LAM, from concerns about hormonal methods to religious beliefs. However, quite often these women are similar in their need to be reassured that LAM's effectiveness has been thoroughly established by scientific study.

A Leader can refer a mother to THE WOMANLY ART OF BREASTFEEDING or Breastfeeding and Fertility' (No. 87). Breastfeeding and Natural Child Spacing, available through the LLLI Catalogue, is the pre-eminent work on the subject and will be helpful to any mother interested in mothering through breastfeeding. Organizations such as the Couple to Couple League can be a resource about LAM as well as other methods of natural family planning. The BREASTFEEDING ANSWER BOOK lists additional resources and organizations.

More on Fertility and Breastfeeding

Additional resources are available from LLLI for those who wish to explore this topic in greater depth.

Toni Weschler's Taking Charge of Your Fertility is newly approved for use in Group Libraries. This comprehensive book describes the menstrual cycle and the signals a woman's body provides to indicate fertility. It includes chapters on reproductive health, natural birth control, achieving pregnancy and the benefits of charting as well as information on fertility awareness during breastfeeding, premenopause and other special circumstances.

For a more scholarly approach to the subject, Leaders may wish to examine Stuart-Macadam and Dettwyler's Breastfeeding: Biocultural Perspectives (No. 334). In Chapter 11, "Breastfeeding, Fertility and Maternal Condition," anthropologist Peter T. Ellison blends information from a variety of disciplines and cultures to explain the interplay between fertility and lactation. The author provides historical information to describe how we came to our current level of understanding and points out the areas that require further investigation.

In Your Fertility Signals (No.376), author Merryl Winstein employs clear diagrams and step-by-step instructions to describe the physical and emotional changes a woman may experience as she moves through her monthly cycle. The effects of special circumstances such as breastfeeding, stress and premenopause are thoroughly discussed. Sus Signos de Fertilidad, the Spanish version of this book, is also available from LLLI (No. 376SP). German and Chinese versions, although not reviewed by the LLLI Book Evaluation Committee (BEC), may be ordered directly from Smooth Stone Press, P.O. Box 19875, St. Louis, Missouri 63144 USA. Any Leader interested in reviewing the German or Chinese edition is encouraged to contact Diane Beckman, BEC Chairman, 319 Dixon Avenue, Cary, North Carolina 27511-3259 USA or DiBeckman at aol.com (email).

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